ORCID Profile
0000-0002-7476-1692
Current Organisations
Curtin University
,
Charles Darwin University
,
University of Notre Dame Australia
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Publisher: Cambridge Media
Date: 2020
Publisher: Wiley
Date: 19-02-2018
DOI: 10.1111/BLD.12217
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2017
DOI: 10.11124/JBISRIR-2016-003155
Abstract: : The objective of this review is to synthesize the best available evidence to determine the incidence and prevalence of falls in adults with intellectual disability living in the community.
Publisher: SAGE Publications
Date: 06-2022
DOI: 10.1177/20101058221111577
Abstract: Physiotherapists play a crucial role in rehabilitating critically ill patients in intensive care units (ICU). However, variations are found in clinical practice amongst physiotherapists working in the ICU, both locally and internationally, due to the lack of minimum clinical standards and varying knowledge on critical care rehabilitation resulting in inconsistent quality of care. To establish a framework of the minimum standards of clinical practice for physiotherapists working in ICU in Singapore and compare the standards with existing literature. A three-round modified Delphi questionnaire survey technique collated responses from ICU physiotherapists. The questionnaire contained 222 items, categorised into assessments, conditions and treatments. Responses to the items were either: “Yes, it is essential”, “No, it is not essential”, or “I am not sure”. Consensus for an item was reached when 70% of participants ranked it essential or non-essential. Participants comprised registered physiotherapists who have worked in the ICU for at least six months in the last 12 months and are currently working in the ICU. 23 physiotherapists (median ICU-experience 7.0 (4.3–9.8) years) gave consent and completed the initial survey. 13 completed all three rounds of questionnaires. Overall, 163 items were regarded as essential, 21 as non-essential, and 38 did not reach consensus. The identified 163 items varied from similar studies due to different scopes of physiotherapy practice and professional autonomy. This framework may guide the content of the physiotherapy education curriculum on critical care rehabilitation and minimise variability in clinical practice across different healthcare institutions in Singapore.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.APMR.2016.10.011
Abstract: To investigate quality of life (QOL) and psychosocial well-being in youth with neuromuscular disorders (NMDs) who are wheelchair users. MEDLINE, Embase, CINAHL, and PsycINFO (January 2004-April 2016) and reference lists of retrieved full-text articles. Peer-reviewed studies were included when data describing self-reported QOL and psychosocial well-being could be separately understood for those using wheelchairs and 12 to 22 years of age. There were 2058 records independently screened, and potentially eligible articles were obtained and examined by all reviewers. Twelve observational and 3 qualitative studies met the inclusion criteria. Population representativeness, measurement tools, and outcomes, where possible, with comparison groups. Two reviewers independently appraised studies for risk of bias to internal validity and generalizability. Heterogeneity of measurement and reporting precluded meta-analysis. Data were cross-sectional only. Compared with same-age typically developing peers, physical QOL was scored consistently and significantly lower in youth with NMDs, whereas psychosocial QOL was not. Psychosocial QOL was highest in youth nonambulant since early childhood and in those recruited via single tertiary specialist clinics. Mental health and social participation could not be compared with same-age populations. Despite low physical QOL, psychosocial QOL in youth with NMDs appeared comparable with same-age peers. The psychosocial well-being of younger adolescents on degenerative disease trajectories appeared most compromised however, the longitudinal effects of growing up with a NMD on mental health and social participation are unknown. Interpretation was h ered by poor description of participant age, sex and physical ability lack of population-based recruitment strategies and inconsistent use of age-appropriate measures. Understanding of self-reported QOL and psychosocial well-being in youth with NMDs transitioning to adulthood is limited.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2019
DOI: 10.11124/JBISRIR-2017-003798
Abstract: The objective of the review was too synthesize the best available evidence on the incidence and prevalence of falls among adults with intellectual disability (ID). Falls among adults with ID frequently cause physical injury and may negatively impact on their quality of life. Studies investigating falls among people with ID have used differing methods and populations, making it difficult to determine the scope and extent of this problem. This review considered all studies that included adults with ID aged 18 years and over and which reported percentage/numbers of in iduals who fell, and the total number of falls and injurious falls sustained from a fall. Studies were included if they were conducted within community or residential settings. Studies that were conducted in hospitals were excluded. Cohort studies, case-control and cross-sectional studies were included. Studies that used an experimental design, both randomized controlled and quasi experimental design, were also included. A three-step search strategy was undertaken for published and unpublished literature in English from 1990 to 2017. An initial search of MEDLINE and CINAHL was undertaken before a more extensive search was conducted using keywords and index terms across 11 electronic databases. Two independent reviewers assessed the methodological quality of the included studies using the Joanna Briggs Institute standardized critical appraisal instrument for prevalence studies (Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data). Data was extracted using the Joanna Briggs Institute's standardized extraction tool. Data that directly reported or could be used to calculate the incidence and prevalence of falls were extracted. Quantitative data for the number (proportion) of people who fell were pooled in statistical meta-analysis using STATA version 14 (Stata Corp LLC, Texas, USA). Data measuring incidence of falls (rate of falls for the duration of the study) and incidence of injurious falls (rate of falls resulting in one or more injuries for the duration of the study) could not be pooled in meta-analysis, hence results have been presented in a narrative form including tables. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes is also reported. Nine studies were eligible for inclusion in this review. Eight articles were observational cohort studies which reported on the incidence revalence of falls as outcome measures, and one article was a quasi-experimental study design. Overall the methodological quality of the included studies was considered moderate. The pooled proportion of people with ID who fell (four studies, 854 participants) was 39% (95% CI [0.35%-0.43%], very low GRADE evidence). The rate of falls (eight studies, 782 participants) ranged from 0.54 to 6.29 per person year (very low GRADE evidence). The rate of injurious falls (two studies, 352 participants) ranged from 0.33 to 0.68 per person year (very low GRADE evidence). Synthesized findings demonstrate that people with ID, who live in community or residential settings, may fall more frequently, and at a younger age, compared to general community populations. Studies should take a consistent approach to measuring and reporting falls outcomes. Further research is recommended to identify the impact of falls on health related outcomes for people with ID and subsequently evaluate falls interventions for their efficacy.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Informa UK Limited
Date: 04-05-2021
Publisher: Elsevier BV
Date: 05-2015
Publisher: Elsevier BV
Date: 05-2015
Publisher: Informa UK Limited
Date: 14-10-2017
Publisher: University of Toronto Press Inc. (UTPress)
Date: 02-2020
Abstract: Purpose: A systematic review was conducted to investigate the effect of respiratory physiotherapy on mortality, quality of life, functional recovery, intensive care length of stay, duration of ventilation, oxygenation, secretion clearance, and pulmonary mechanics for invasively ventilated adults with pneumonia. Method: Five databases were searched for randomized trials published between January 1995 and November 2018. Study quality was assessed using a standardized Joanna Briggs Institute critical appraisal tool, and Review Manager software was used to pool the studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the level of certainty of the evidence. Results: A total of 14 studies of moderate quality included 251 subjects with pneumonia. Eight studies were pooled for meta-analysis. Interventions that increased inspiratory volume appeared to benefit secretion clearance by nearly 2 grams (mean difference [MD] 1.97 95% CI: 0.80, 3.14 very low GRADE evidence) and increase static lung compliance immediately after treatment by more than 5 millilitres/centimetre H 2 0 (MD 5.40 mL/cm H 2 O 95% CI: 2.37, 8.43 very low GRADE evidence) or by more than 6 millilitres/centimetre H 2 O after a 20- to 30-minute delay (MD 6.86 mL/cm H 2 O 95% CI: 2.86, 10.86 very low GRADE evidence). No adverse events were found. Conclusions: Respiratory physiotherapy that increases tidal volume may benefit secretion clearance and lung compliance in invasively ventilated adults with pneumonia, but its impact on other outcomes, including mortality, length of stay, and other patient-centred outcomes, is unclear, and further research is required.
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.NMD.2018.08.013
Abstract: The physical and social challenges associated with neuromuscular disorders may impact mental wellbeing in non-ambulant youth during the more vulnerable period of adolescence. This cross-sectional survey investigated non-ambulant youths' mental wellbeing and relationships with physical health, participation and social factors. The conceptual model was the International Classification of Functioning, Disability and Health (ICF). Thirty-seven youth aged 13-22 years old (mean age 17.4 years n = 30 male n = 24 Duchenne Muscular Dystrophy) and their parents provided biopsychosocial data through a comprehensive self-report questionnaire. The primary outcome measure was the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). Relationships between mental wellbeing and variables within and across each ICF domain were explored using linear regression models. Mean WEMWBS scores (55.3/70 [SD 8.1]) were higher than for typically developing youth and comparable to youth with other chronic conditions. Over half of youth reported severe co-morbidities across all body systems. Multivariable modelling indicated that mental wellbeing was independently associated with academic achievement and perceived family support but not with physical health variables. Beyond management of physical co-morbidities, enabling youths' educational attainment and attending to social support likely optimises youth's wellbeing.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.JCRC.2013.02.012
Abstract: This study aimed to report mortality, morbidity, and the relationship between these outcomes with physical function in patients who survived prolonged mechanical ventilation during an intensive care unit (ICU) admission. Records were reviewed for Western Australian residents admitted to an ICU in 2007 or 2008 who were ventilated for 7 days or longer and survived their acute care stay. Records were linked with data maintained by the Department of Health. A total of 181 patients (aged 52 ± 19 years) were included in this study. In the 12 months after discharge, 159 (88%) survived and 148 (82%) had been hospitalized. Compared with those who were ambulating independently when discharged from acute care, those who were not had more admissions (incident rate ratio, 1.81 95% confidence interval, 1.28-2.57) and a greater cumulative length of hospital stay (10 [37] vs 57 [115] days, P < .001) over the first 12 months after discharge. Time between admission to ICU and when the patient first stood correlated with the number of admissions (Rs = 0.320, P < .001) and cumulative length of stay (Rs = 0.426, P < .001) in the 12 months after discharge. For survivors of prolonged mechanical ventilation, physical function during acute care was associated with hospitalization over the following 12 months.
Publisher: Wiley
Date: 27-03-2017
DOI: 10.1111/JEP.12722
Abstract: Community-acquired pneumonia (CAP) is a common cause for intensive care unit (ICU) admission resulting in high morbidity and mortality. There is a paucity of evidence regarding respiratory physiotherapy for intubated and mechanically ventilated patients with CAP, and anecdotally clinical practice is variable in this cohort. The aims of this study were to identify the degree of variability in physiotherapy practice for intubated adult patients with CAP and to explore ICU physiotherapist perceptions of current practice for this cohort and factors that influence physiotherapy treatment mode, duration, and frequency. A survey was developed based on common aspects of assessment, clinical rationale, and intervention for intubated and mechanically ventilated patients. Senior ICU physiotherapists across 88 Australian public and private hospitals were recruited. The response rate was 72%. Respondents (n = 75) stated their main rationale for providing a respiratory intervention were improved airway clearance (98%, n = 60/61), alveolar recruitment (74%, n = 45/61), and gas exchange (33%, n = 20/61). Respondents estimated that average intervention lasted between 16 and 30 minutes (70% of respondents, n = 41/59) and would be delivered once (44%) or twice (44%) daily. Results indicated large variability in reported practice however, trends existed regarding positioning in alternate side-lying (81%, n = 52/64) or affected lung uppermost (83%, n = 53/64) and use of hyperinflation techniques (81%, 52/64). Decisions regarding duration were reported to be based on sputum volume (95%), viscosity (93%) and purulence (88%), cough effectiveness (95%), chest X-ray (87%), and auscultation (84%). Sixty percent reported that workload and staffing affected intervention duration and frequency. Intervention time was more likely increased when there was greater staffing (P = .03). Respiratory physiotherapy treatment varies for intubated patients with CAP. Further research is required to determine what is considered best practice for this patient population.
Publisher: Hindawi Limited
Date: 03-03-2023
DOI: 10.1155/2023/6544215
Abstract: Aim. To identify, integrate, and appraise the evidence on hospitalised smokers’ and staff perspectives of inpatient smoking cessation interventions and the impact on smokers’ quality of life. Design. The integrative review method was used to present hospitalised smokers’ and staff perspectives of inpatient smoking cessation interventions. Search Method. This integrative review consisted of a comprehensive search on smoking cessation interventions that take place during an inpatient admission to hospital for adults ( age 18 years) of the following online databases: Ovid Medline, Joanna Briggs Institute, APA PsycInfo, CINAHL, Cochrane, Google Scholar, PEDro, and Scopus. The search strategy was inclusive of peer-reviewed studies limited to the English language or translated to English. A search of grey literature and manual searching of reference lists was also conducted to identify further studies not identified in the online database search. All studies that produced any qualitative data (i.e., qualitative, mixed methods, and surveys) on inpatient-initiated smoking cessation programs were included. Outcomes of interest are included but were not limited to education, counselling, and the use of pharmacotherapy. Studies undertaken in the psychiatric, adolescent, and paediatric settings were excluded. Results. The key findings from this integrative review included positive evaluations from both patients and staff involved in inpatient smoking cessation interventions, reporting that hospitalisation was an appropriate opportunity to address smoking cessation. A number of facilitators and barriers to inpatient smoking cessation interventions included creating a supportive patient-centred environment and consideration of the cost of nicotine replacement therapy and time to deliver inpatient smoking cessation interventions. Recommendations references for future inpatient smoking cessation interventions included the use of a program ch ion and ongoing education to demonstrate the effectiveness of the intervention, and despite the cost of nicotine replacement therapy being identified as a potential barrier, it was identified as a preference for most patients. Although quality of life was only evaluated in two studies, statistically significant improvements were identified in both. Conclusion. This qualitative integrative review provides further insight into both clinician and patient participants’ perspectives on inpatient smoking cessation interventions. Overall, they are seen to produce positive benefits, and staff training appears to be an effective means for service delivery. However, insufficient time and lack of resources or expertise appear to be consistent barriers to the delivery of these services, so they should be considered when planning the implementation of an inpatient smoking cessation intervention.
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Elsevier BV
Date: 10-2018
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.JCRC.2011.12.020
Abstract: The purposes were to assess the functional recovery of those who survived a prolonged intensive care unit (ICU) stay by reporting the proportion who were able to ambulate independently at hospital discharge and also to examine if the time duration between admission and when the patient first stood impacted on their capacity to ambulate at discharge. A retrospective review was conducted of medical records of ICU patients in 2007 to 2008, who were mechanically ventilated for 168 hours or more, and survived their acute care stay. Main outcome measures were (1) ambulation status before admission and at time of hospital discharge and (2) time between admission to the ICU and when the patient first stood. A total of 190 patients were included. Before admission, 189 (99% 95% confidence interval [CI], 98%-100%) were ambulating independently, of whom 180 (95%) did not require a gait aid. On discharge from acute care, 89 (47% 95% CI, 40%-54%) were ambulating independently, of whom 54 (61%) did not require a gait aid. Compared with those who stood within 30 days of ICU admission, a delay in standing of between 30 and 60 days increased the odds 5-fold (95% CI, 2-11) of being unable to ambulate independently at the time of discharge. After a prolonged ICU admission, more than 50% of patients were unable to ambulate independently by hospital discharge, with the time between admission and first stand, being an important predictor of this outcome.
Publisher: Wiley
Date: 08-2000
DOI: 10.1002/PRI.196
Abstract: Manual hyperinflation (MH) of the lungs is commonly used by physiotherapists in the treatment of intubated mechanically ventilated patients with the aim of increasing alveolar oxygenation, reversing atelectasis or mobilizing pulmonary secretions. However, the efficacy of MH, used in isolation, has not been clearly established. This randomized, controlled trial investigated the effects of MH on lung compliance (CL), the arterial oxygen to fraction of inspired oxygen ratio (PaO2:FIO2) and the alveolar-arterial oxygen tension difference (A-a)PO2 in 100 medically stable, mechanically ventilated subjects who had undergone coronary artery surgery (CAS). Post-CAS subjects were used for this study as they constitute a large, homogeneous and accessible group. Subjects were randomized to either a control group (non-MH group) or to a treatment group (MH group) which received MH within four hours of surgery. After four minutes of MH there were significant improvements in CL, PaO2:FIO2 and (A-a)PO2 with values remaining above baseline measures at 60 min post-intervention. The mean improvement in CL was 6 ml/cmH2O (approximately 15%), 56 mmHg for PaO2:FIO2 (approximately 17%) and 29 mmHg for (A-a)PO2 (approximately 17%) immediately post-intervention. No significant changes in mean CL, PaO2:FIO2 or (A-a)PO2 were seen in the non-MH group. MH performed in the stable ventilated patient significantly increased CL and PaO2:FIO2 and decreased (A-a)PO2, but the clinical significance of this improvement is unclear. Further investigations are required to validate the findings of this study as well as to determine the therapeutic value of MH on patient outcome.
Publisher: Elsevier BV
Date: 05-2015
Publisher: MyJove Corporation
Date: 30-11-2022
DOI: 10.3791/64667
Publisher: Wiley
Date: 27-07-2011
DOI: 10.1111/J.1365-2753.2010.01480.X
Abstract: Pulmonary dysfunction (PDF) in intubated patients remains a serious and costly complication of intensive care unit care. Optimal cardiopulmonary therapy strategies to prevent and manage PDF need clarification to reduce practice variability. The purpose of this paper is to report on the content validation of an evidence-based clinical management algorithm (EBCMA) aimed at the prevention, identification and management of PDF in critically ill patients. Forty-four draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by research clinicians (n = 7) in an electronic three-round Delphi process. Statements which reached a priori defined consensus [semi-interquartile range (SIQR) <0.5] were collated into the EBCMA. One hundred per cent response rate. Forty-four statements were added after round one. Consensus was reached on rating of 83% (73/88) statements. Differences in interpretation of the existing evidence base, and variations in accepted clinical practice were identified. Four themes were identified where panel failed to reach consensus. The internationally agreed hierarchical framework of current available evidence and clinical expertise developed through this Delphi process provides clinicians with a tool to inform clinical practice. This tool has the potential to reduce practice variability thereby maximizing safety and treatment outcome. The clinical utility of the EBCMA requires further evaluation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2017
DOI: 10.11124/JBISRIR-2016-003145
Abstract: The objective of the review is to map evidence on the efficacy of a respiratory physiotherapy intervention for intubated and mechanically ventilated adults with community acquired pneumonia (CAP). Specifically, the review seeks to investigate if respiratory physiotherapy interventions can achieve the following for intubated and mechanically ventilated adults with CAP: Improve airway clearance, respiratory mechanics and oxygenation. Reduce mechanical ventilation time, time taken to stand up and/or walk, intensive care length of stay and hospital length of stay. Improve quality of life. Reduce mortality.
Publisher: Elsevier BV
Date: 07-2018
Publisher: Springer Science and Business Media LLC
Date: 30-07-2018
Publisher: BMJ
Date: 15-11-2019
Publisher: No publisher found
DOI: 10.1037/T58280-000
Publisher: Elsevier BV
Date: 2007
DOI: 10.1016/S0004-9514(07)70009-0
Abstract: How often do adverse events (including adverse physiological changes) occur during physiotherapy intervention in intensive care? A multi-centre prospective observational study. Five tertiary level university-affiliated intensive care units. All physiotherapy intervention in five intensive care units over a three month period. When certain specified changes occurred during physiotherapy intervention, details were noted including diagnosis of patient, intervention, vital signs, radiological changes, co-morbidities, chemical pathology, and fluid balance. 12 281 physiotherapy interventions were completed with 27 interventions resulting in adverse physiological changes (0.2%). This incidence was significantly lower than a previous study of adverse physiological changes (663 events in 247 patients over a 24-hour period) the incidence during physiotherapy intervention was lower than during general intensive care. Common factors in the patients who had an adverse physiological change were a deterioration in cardiovascular status (ie, decrease in blood pressure or arrhythmia) in patients on medium to high doses of inotropes/vasopressors, unstable baseline hemodynamic values, previous cardiac co-morbidities and intervention consisting of positive pressure or right side lying. The incidence of adverse events during physiotherapy intervention in these five tertiary hospitals was low, demonstrating that physiotherapy intervention in intensive care is safe.
Publisher: Informa UK Limited
Date: 30-12-2014
DOI: 10.3109/17518423.2014.993771
Abstract: We explored parents', children's and physiotherapists' experiences of regular CoughAssist® use, along with their perceptions of its value as an adjunct to in their daily, home respiratory management. All children in the care of a specialist neuromuscular service who regularly used a CoughAssist® device at home participated. Qualitative case study methods involved semi-structured interviews with three children with neuromuscular disorders (NMD), their parents and physiotherapist. Data were analysed using thematic content analysis. Participants (n = 9) perceived the CoughAssist® held benefits for physical, social and emotional aspects of living with NMD. Poor adherence was identified as the major barrier to effective use, governed by factors including child's resistance, time constraints, treatment preference, practitioner support and fear of pressure trauma. Barriers to regular CoughAssist® use must be identified and in idually addressed to enable uptake into respiratory care, accurately measure its effectiveness and realise its perceived benefits to children with NMD.
Publisher: Wiley
Date: 29-09-2014
DOI: 10.1111/JEP.12257
Abstract: Physiotherapists form an important part of the inter-professional team that cares for critically ill patients in intensive care units (ICU). No formalized clinical practice guidelines or standards exist for the educational profile or scope of practice requirements for physiotherapy within critical care, which poses a threat to physiotherapy practice and professional credibility. The aim of this paper was to describe the nominal group technique (NGT) used to identify the minimum standards of clinical practice needed by physiotherapists to ensure safe and independent practice in South African ICUs. Twenty-five subjects participated in one of three forums. Sixty-six concepts were considered in the three domains (knowledge, skills and attitudes). Not all concepts were discussed by all three focus groups. Just over half (54% n=14) the concepts generated in the knowledge domain a third of the concepts (35% n=7) generated in the skills domain and only 10% (n=2) of attitudes were consistently raised by all three groups. Almost two-thirds of the concepts generated (62% n=41) were considered in more than one domain. Only six concepts reached the threshold consensus level across all three focus groups, four knowledge parameters and two skills. The NGT allowed for the cross-stimulation of ideas in an engaging yet anonymous and structured manner. The importance of discussion in reaching consensus is highlighted. Going forward, it is intended to use the concepts generated through this process as the foundation for further consensus-building activities among the wider physiotherapy and intensive care communities.
Publisher: Wiley
Date: 26-05-2017
DOI: 10.1111/JEP.12774
Abstract: Physiotherapists are integral members of the intensive care unit (ICU) team. Clinicians working in ICU are dependent on their own experience when making decisions regarding in idual patient management thus resulting in variation in clinical practice. No formalized clinical practice guidelines or standards exist for the educational profile or scope of practice requirements for ICU physiotherapy. This study explored perceptions of physiotherapists on minimum clinical standards that ICU physiotherapists should adhere to for delivering safe, effective physiotherapy services to critically ill patients. Experienced physiotherapists offering a service to South African ICUs were purposively s led. Three focus group sessions were held in different parts of the country to ensure national participation. Each was audio recorded. The stimulus question posed was “What is the minimum standard of clinical practice needed by physiotherapists to ensure safe and independent practice in South African ICUs?” Three categories were explored, namely, knowledge, skill, and attributes. Themes and subthemes were developed using the codes identified. An inductive approach to data analysis was used to perform conventional content analysis. Twenty‐five physiotherapists participated in 1 of 3 focus group sessions. Mean years of ICU experience was 10.8 years (±7.0 range, 3‐33). Three themes emerged from the data namely, integrated medical knowledge, multidisciplinary teamwork, and physiotherapy practice. Integrated medical knowledge related to anatomy and physiology, conditions that patients present with in ICU, the ICU environment, pathology and pathophysiology, and pharmacology. Multidisciplinary teamwork encompassed elements related to communication, continuous professional development, cultural sensitivity, documentation, ethics, professionalism, safety in ICU, and technology. Components related to physiotherapy practice included clinical reasoning, handling skills, interventions, and patient care. The information obtained will be used to inform the development of a list of standards to be presented to the wider national physiotherapy and ICU communities for further consensus‐building activities.
Publisher: Informa UK Limited
Date: 1998
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-08-2023
DOI: 10.1097/CPT.0000000000000236
Abstract: The aim of this study was to report on the cardiorespiratory assessments, interventions, and outcome measures used by physical therapists with critically ill patients and the impact of COVID-19. An anonymous international online survey of practice (through Google Forms) of physical therapists was conducted. The study was conducted in adult intensive care units. A total of 309 physical therapists participated in the study. A survey was used to determine current cardiopulmonary physical therapy practices in ICU. Predominantly participants were female (74%), aged 31 to 40 years (40%), having worked in intensive care unit (ICU) for either 0 to 5 years (38%) or 11 to 20 years (28%), and worked full time (72%). Most participants worked in the United Kingdom (36%), Europe (21%), or Australia/Oceania (18%). The 3 most frequently reported assessment indicators for cardiopulmonary physical therapy interventions were lobar collapse/atelectasis, audible secretions, and decreased/added lung auscultation sounds. The 3 most commonly used outcome measures included lung auscultation, arterial blood gas analysis, and transcutaneous arterial saturation. The 3 most commonly used physical therapy interventions (“very often” in a descending order) included patient mobilization, repositioning to optimize gas exchange, and endotracheal suctioning. For the COVID-19 cohort, participants reported similar use of patient repositioning to optimize gas exchange and postural drainage, and lower use of patient mobilization and endotracheal suctioning, deep breathing exercises, active cycle of breathing technique, and oropharyngeal suctioning. This survey reports on the characteristics of physical therapists who work in ICU, and their cardiopulmonary physical therapy assessments, interventions, and outcome measures most commonly used, inclusive of patients with COVID-19. There were some differences in interventions provided to the COVID-19 cohort compared with the non–COVID-19 cohort.
Publisher: Wiley
Date: 10-02-2020
DOI: 10.1111/JAR.12704
Publisher: Springer Science and Business Media LLC
Date: 24-09-2008
DOI: 10.1007/S00134-008-1278-2
Abstract: To investigate the effect of respiratory physiotherapy on the prevention and treatment of ventilator-associated pneumonia (VAP) for adults in an intensive care unit (ICU) with an acquired brain injury (ABI). Two-part, prospective, randomised controlled trial. A total of 144 subjects with ABI admitted with a Glasgow Coma Scale 24 h 33 subjects were subsequently diagnosed with VAP. Respiratory physiotherapy comprised six treatments (positioning, manual hyperinflation and suctioning) in each 24-h period whilst on MV. The Control Group received standard medical/nursing care but no respiratory physiotherapy. There were no significant differences between groups for incidence of VAP, duration of MV, length of ICU stay or clinical variables such as requirement for re-ventilation. In adults with ABI, regular respiratory physiotherapy in addition to routine medical/nursing care does not appear to prevent VAP, reduce length of MV or ICU stay. Due to small numbers, it is not possible to draw any conclusions as to whether or not respiratory physiotherapy hastens recovery from VAP.
Publisher: Springer Science and Business Media LLC
Date: 29-10-2016
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.AUCC.2017.10.001
Abstract: Community acquired pneumonia (CAP) is a common reason for admission to an intensive care unit for intubation and mechanical ventilation, and results in high morbidity and mortality. The primary aim of the study was to investigate availability and provision of respiratory physiotherapy, outside of normal business hours, for intubated and mechanically ventilated adults with CAP in Australian hospitals. A cross-sectional, mixed methods online survey was conducted. Participants were senior intensive care unit physiotherapists from 88 public and private hospitals. Main outcome measures included presence and nature of an after-hours physiotherapy service and factors perceived to influence the need for after-hours respiratory physiotherapy intervention, when the service was available, for intubated adult patients with CAP. Data were also collected regarding respiratory intervention provided after-hours by other ICU professionals. Response rate was 72% (n=75). An after-hours physiotherapy service was provided by n=31 (46%) hospitals and onsite after-hours physiotherapy presence was limited (22%), with a combination of onsite and on-call service reported by 19%. Treatment response (83%) was the most frequent factor for referring patients with CAP for after-hours physiotherapy intervention by the treating day-time physiotherapist. Nurses performing respiratory intervention (77%) was significantly associated with no available after-hours physiotherapy service (p=0.04). Physiotherapy after-hours service in Australia is limited, therefore it is common for intubated patients with CAP not to receive any respiratory physiotherapy intervention outside of normal business hours. In the absence of an after-hours physiotherapist, nurses were most likely to perform after-hours respiratory intervention to intubated patients with CAP. Further research is required to determine whether the frequency of respiratory physiotherapy intervention, including after-hours provision of treatment, influences outcomes for ICU patients intubated with pneumonia.
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.AUCC.2011.06.001
Abstract: Falling among adults in acute care is an important problem with falls rates in tertiary hospitals ranging from 2% to 5%. Factors that increase the risk of falling, such as advanced age, altered mental status, medications that act on the central nervous system and poor mobility, often characterise in iduals who survive a prolonged intensive care unit (ICU) admission. To measure the incidence of falls and describe the characteristics of fallers among intensive care survivors. A comprehensive retrospective chart review was undertaken of 190 adults who were intubated and ventilated for ≥ 168 h and survived their acute care stay. Using a standardised form, several variables were extracted including falls during hospitalisation and risk factors such as age, severity of illness, and length of stay in intensive care and hospital. Thirty-two (17%, 95% confidence interval 11.5-22.2%) patients fell at least once on the in-patient wards following their ICU stay. Compared with non-fallers, fallers were younger (53.2 ± 17.9 vs. 44.1 ± 18.3 years p=0.009) and had a shorter duration of inotropic support in ICU (84 ± 112 vs. 56 ± 100 h p=0.040). The majority of fallers were aged less than 65 years (84%). Both fallers and non-fallers had similar APACHE II scores (20 ± 8 vs. 21 ± 7 p=0.673), length of stay in intensive care (14.2 ± 8.7 vs. 14.0 ± 9.7 days p=0.667) and hospital length of stay (43.9 ± 33.1 vs. 41.0 ± 38.8 days p=0.533). Falling during hospitalisation is common in intensive care survivors. Compared with non-fallers, fallers were younger and required inotropes for a shorter duration. Those who survive a prolonged admission to an ICU may benefit from specific assessment of balance and falls risk by the multidisciplinary team.
Publisher: Wiley
Date: 06-2001
DOI: 10.1002/PRI.219
Abstract: The present study aimed to evaluate the consistency with which physiotherapists apply manual hyperinflation to a test lung using the Air-Viva-2 or Mapleson-B resuscitation circuit, and their ability to modify the technique as pulmonary characteristics change. A quasi-experimental, randomized, repeated-measures design was used to study 16 volunteer physiotherapists performing manual hyperinflation to a test lung simulating three clinical situations. Each subject applied manual hyperinflation to the test lung for each simulation three times in one day using the resuscitation circuit that they would normally use in their clinical practice. Eight subjects used the Air-Viva-2 circuit and eight used the Mapleson-B circuit. Measurements of tidal volume (Vp), peak airway pressure (Paw) and fraction of delivered oxygen (FDO2) were recorded during each testing period. Inflation rate and minute volume were calculated. As compliance decreased and airway resistance increased, VT decreased and Paw increased. Of the eight subjects using the Air-Viva-2 circuit, only three subjects delivered greater than 0.80 FDO2. All subjects using the Mapleson-B circuit delivered greater than 0.85 FDO2. Subjects demonstrated good consistency in the application of manual hyperinflation for all three simulations and modified their technique appropriately as simulated pulmonary characteristics changed.
Publisher: Springer Science and Business Media LLC
Date: 15-08-2017
Publisher: Wiley
Date: 09-09-2019
DOI: 10.1111/JIR.12686
Abstract: People with intellectual disability (ID) experience age-related changes earlier in life, and as such, falls among people with ID are of serious concern. Falls can cause injury and consequently reduce quality of life. Limited studies have investigated the incidence of falls among people with ID and the associated risk factors. The purpose of this study was to investigate the incidence of falls and risk factors for falling in people with ID living in the community. A prospective observational cohort (n = 78) of community-dwelling adults with ID. Characteristics measured at baseline included falls history, medication use, balance and mobility. Falls were reported for 6 months using monthly calendars and phone calls. Data were analysed using univariate and multivariate logistic regression to identify risk factors associated with falling. Participants [median (interquartile range) age 49 (43-60) years, female n = 32 (41%)] experienced 296 falls, with 36 (46.2%) participants having one or more falls. The incidence of falls was 5.7 falls (injurious falls = 0.8) per person year (one outlier removed from analysis). A history of falls [adjusted odds ratio (OR): 6.37, 95% confidence interval (CI) (1.90-21.34)] and being ambulant [adjusted OR: 4.50, 95% CI (1.15-17.67)] were associated with a significantly increased risk of falling. Falls were significantly less frequent among participants taking more than four medications [adjusted OR: 0.22, 95% CI (0.06-0.83)] and participants who were continent [adjusted OR: 0.25, 95% CI (0.07-0.91)]. People with ID fall at a younger age compared with the broader community. The associated falls risk factors also differ to older community-dwelling adults. Health professionals should prioritise assessment and management of falls risk in this population.
Publisher: Elsevier BV
Date: 03-2017
Publisher: Springer Science and Business Media LLC
Date: 08-11-2021
DOI: 10.1186/S13054-021-03794-0
Abstract: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5L TM . Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51–70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06–13.77] p 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5L TM utility score (MD, − 0.19 [− 0.28 to − 0.10] p 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020.
Publisher: Japanese Physical Therapy Association
Date: 20-04-2021
DOI: 10.1298/PTR.E10060
Publisher: Elsevier BV
Date: 03-2017
Publisher: Informa UK Limited
Date: 03-06-2016
DOI: 10.3109/09593985.2016.1145311
Abstract: Achieving competency in critical care in entry-level physiotherapy courses across Australia and New Zealand is not essential, and accredited training for qualified physiotherapists working in critical care units is lacking. As a result, practice standards and training may vary. The objective was to establish consensus-based minimum clinical practice standards for physiotherapists working in critical care settings in Australia and New Zealand. A modified Delphi technique, which consisted of three rounds of questionnaires, was used to obtain consensus on items. Australian and New Zealand critical care settings. A panel (n = 61) was invited from a pool of eligible physiotherapists throughout Australia and New Zealand (n = 93). Eligibility criteria were defined a-priori on the basis of possession of expertise and experience in the practice and teaching of critical care physiotherapy clinical skills. Questionnaires were disseminated electronically (either via email, or SurveyMonkey Fifty physiotherapists consented and participated in the initial Delphi round, of whom 45 (90%) completed all rounds. Consensus was reached on 199 (89%) items. The panel agreed that 132 (58%) items were 'Essential' items for inclusion in the final framework. This is the first study to develop a consensus framework of minimum standards of practice for physiotherapists working in critical care. The clinical utility of this framework now requires assessment.
Publisher: Elsevier BV
Date: 11-2016
Publisher: Wiley
Date: 19-12-2019
DOI: 10.1111/JEP.13077
Abstract: Patients with community-acquired pneumonia (CAP) are frequently admitted to an intensive care unit. Physiotherapy may be provided to optimize respiratory function however, there is significant variability in clinical practice and limited research directing best practice for this cohort. This study aimed to determine expert consensus for best physiotherapy practice for invasively ventilated adults with CAP. A modified Delphi technique involved an international expert panel completing three rounds of an online questionnaire. The initial 35-statement questionnaire, based on a systematic literature review and survey of current clinical practice, covered physiotherapy assessment and treatment of intubated patients with CAP. Quantitative data using Likert scales determined level of agreement, with qualitative data collected through open-ended responses. Consensus threshold was set a priori at 70%. Items not achieving consensus were modified and new items added based on themes from qualitative data. Quantitative data were analysed descriptively, with thematic analysis used on qualitative data. The panel comprised 29 international clinical and academic experts in critical care physiotherapy. Response rate was more than 95% for each round. Outcome achieved was 38 consensus statements covering assessment and treatment, with 28 statements (74%) providing consensus on recommended clinical practice, two consensus disagreement statements (7%) for what practice is not recommended, and eight statements (21%) indicating which treatments may be beneficial. Expert consensus regarding physiotherapy for intubated adults with CAP patients provides an evidence-based approach to guide clinical practice. The consensus statements can also be used to guide research evaluating physiotherapy interventions for patients with CAP.
Publisher: Elsevier BV
Date: 2001
DOI: 10.1016/S0004-9514(14)60294-4
Abstract: This randomised controlled clinical trial investigated whether physiotherapy during the period of mechanical ventilation following cardiac surgery influenced subject outcomes. Two hundred and thirty-six subjects admitted to the intensive care unit (ICU) following elective or semi-urgent cardiac surgery were randomised to either a treatment group, which received physiotherapy during the intubated phase, or a control group where physiotherapy was commenced only once the subject was extubated. No significant differences between the two groups were detected for length of intubation period, length of ICU stay, length of hospital stay, maximal daily incentive spirometry values or the incidence of post-operative pulmonary complications. For in iduals following routine uncomplicated cardiac surgery, the provision of physiotherapy interventions during the post-operative intubation period does not improve outcomes.
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.GERINURSE.2015.02.025
Abstract: Optimum recovery from hip fracture has been linked to the provision of effective rehabilitation, but levels of adherence vary among older patients. In this feasibility study a novel personalized DVD was designed for four participants, which delivered a 5 week tailored home exercise program (HEP), with the participant being videoed completing their exercises. Treatment fidelity of the DVD HEP was evaluated, including participants' perceptions of and response to the DVD-HEP, which was explored using diaries and interviews and analyzed thematically. Secondary outcome measures including exercise adherence and self-efficacy for exercise were analyzed using descriptive statistics. Levels of adherence to the HEP were 1.2-3.5 times more than the minimum prescribed dose and participants demonstrated higher levels of self-efficacy for exercise. Adherence was found to be enhanced by physical improvement, positive self-reflection about engagement in the DVD-HEP, the format of the DVD, and increased self-efficacy. Personalized DVDs may be a feasible method of promoting adherence to home exercise programs among older patients.
Publisher: SAGE Publications
Date: 09-10-2010
Abstract: Answers were sought to the following question: Are techniques, applied predominantly with the aim of clearing secretions from the airways, to patients during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), safe and effective? A systematic review was undertaken of studies that (i) were either randomized controlled or randomized cross-over trials, (ii) recruited patients during an AECOPD, (iii) reported the results of between-group analyses and (iv) investigated the effect of techniques applied primarily with the aim of clearing secretions from the airways. Studies that examined non-invasive positive pressure ventilation (NIPPV) and early rehabilitation were excluded. Data were extracted pertaining to resting lung function, gas exchange, sputum expectoration, symptoms, NIPPV use and hospital stay. Five studies were included with a mean Physiotherapy Evidence Database (PEDro) score of 4.4 ± 1.1 (range: 3—6). The main findings were that (i) airway clearance techniques did not improve measures of resting lung function or produce any consistent change in measures of gas exchange, (ii) the application of 5 min of continuous chest wall percussion reduced forced expiratory volume in 1 second (FEV 1 ), (iii) in people with copious secretions, mechanical vibration, and non-oscillating positive expiratory pressure (PEP) mask therapy increased sputum expectoration and (iv) in patients with hypercapnic respiratory failure, intrapulmonary percussive ventilation (IPV) and PEP mask therapy reduced the need for, and duration of, NIPPV, respectively. With the exception of continuous chest wall percussion, airway clearance techniques were safe in patients during an AECOPD. Vibration and non-oscillating PEP facilitated sputum expectoration in patients characterized by copious airway secretions. In patients with respiratory failure, techniques that apply a positive pressure to the airways may reduce either the need for, or duration of, NIPPV and hospital length of stay.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Wiley
Date: 29-11-2013
DOI: 10.1111/JPM.12122
Abstract: Good mental health is imperative to well-being. Symptoms of fatigue, chronic pain and poor sleep are common in people with mental illness and contribute to substantial loss of functioning. Physical exercise interventions have shown to decrease these symptoms in a range of populations however, their possible association with physical activity related to day-to-day functioning have not been explored in people hospitalized with severe mental illness. Inpatients (n = 4) of a metropolitan mental health facility were fitted with an Actiwatch, which collected physical activity and sleep measures for an anticipated 14-day data collection period. During this time, morning and evening pain and fatigue scores were collected on an 11-point numerical rating scale. Significant associations were found between morning pain and morning fatigue scores (β = -0.44, P = 0.023), morning pain and physical activity (β = 12.34, P = 0.042), and physical activity and evening pain scores (β = 0.20, P = 0.017). Fatigue tended towards interfering more with quality of life than did pain, but this was not significant (P = 0.07). This study provided preliminary data suggesting associations between pain and fatigue, and intensity of pain and physical activity levels. This information can be used to generate hypotheses for future clinical trials.
Publisher: Elsevier BV
Date: 2022
Publisher: American Thoracic Society
Date: 15-05-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2016
DOI: 10.1097/CCM.0000000000001643
Abstract: To determine if the early goal-directed mobilization intervention could be delivered to patients receiving mechanical ventilation with increased maximal levels of activity compared with standard care. A pilot randomized controlled trial. Five ICUs in Australia and New Zealand. Fifty critically ill adults mechanically ventilated for greater than 24 hours. Patients were randomly assigned to either early goal-directed mobilization (intervention) or to standard care (control). Early goal-directed mobilization comprised functional rehabilitation treatment conducted at the highest level of activity possible for that patient assessed by the ICU mobility scale while receiving mechanical ventilation. The ICU mobility scale, strength, ventilation duration, ICU and hospital length of stay, and total inpatient (acute and rehabilitation) stay as well as 6-month post-ICU discharge health-related quality of life, activities of daily living, and anxiety and depression were recorded. The mean age was 61 years and 60% were men. The highest level of activity (ICU mobility scale) recorded during the ICU stay between the intervention and control groups was mean (95% CI) 7.3 (6.3–8.3) versus 5.9 (4.9–6.9), p = 0.05. The proportion of patients who walked in ICU was almost doubled with early goal-directed mobilization (intervention n = 19 [66%] vs control n = 8 [38%] p = 0.05). There was no difference in total inpatient stay (d) between the intervention versus control groups (20 [15–35] vs 34 [18–43] p = 0.37). There were no adverse events. Key Practice Points: Delivery of early goal-directed mobilization within a randomized controlled trial was feasible, safe and resulted in increased duration and level of active exercises.
No related grants have been discovered for Shane Patman.